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1.
Mycoses ; 63(1): 113-118, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31642133

RESUMO

Onychomycosis (OM), has a worldwide prevalence of 5% and 0.5%-5% in India. Trichophyton. rubrum (T rubrum) and T mentagrophytes are the most commonly isolated fungi. As the clinical and mycological characteristics change with time and geographical region; it is important to study the temporal and topographic patterns periodically. The study was conducted to identify the epidemiological and clinico-mycological characteristics of patients with OM attending a tertiary care hospital in Delhi. Hundred patients with clinical diagnosis of OM were recruited. Among these, 88 patients who tested positive for OM on direct microscopy with KOH, culture and/or histopathology with periodic acid-Schiff were included in the study. The clinico-mycological characteristics and risk factors associated with OM were evaluated. OM was more common in males (M:F = 2.5:1). The mean age of patients with OM was 39 ± 15.3 years (SE 1.52) with mean disease duration of 27.6 ± 46.1 months (SE 4.9). Seventeen (19.3%) patients had concomitant diabetes mellitus. The patients displayed mean body mass index (BMI) of 25.67 ± 1.35 kg/sq m. Concurrent dermatophytosis of skin was present in 35 (39.77%) patients. Two feet-one hand syndrome was present in 5 patients. Fingernail involvement without toenail involvement was more common than toenail involvement alone. (43.18% vs 38.63%). Distal and lateral subungual OM (DLSO) was the commonest clinical variant (81.8%). Mycological culture showed growth in 47 (53.40%) patients. Dermatophytes were isolated in majority, that is in 30 (63.82%) patients followed by non-dermatophytic moulds (NDM) in 7 (14.8%) and Candida spp. in the remaining 10 (21.27%) patients.


Assuntos
Unhas/microbiologia , Onicomicose , Adolescente , Adulto , Idoso , Arthrodermataceae/isolamento & purificação , Candida/isolamento & purificação , Estudos Transversais , Diabetes Mellitus , Feminino , Dermatoses do Pé/microbiologia , Dermatoses da Mão/microbiologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Unhas/patologia , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Onicomicose/patologia , Prevalência , Fatores de Risco , Centros de Atenção Terciária , Tinha/diagnóstico , Trichophyton/isolamento & purificação , Adulto Jovem
3.
Mycopathologia ; 184(5): 683-689, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31502093

RESUMO

Opportunistic fungal infections of the skin and nail are frequently encountered in human. Recent years have shown increased incidence of fungal infections especially in immunocompromised patients. Onychomycosis in HIV-infected patients is reported to occur in 15-40%, four times more than in the general population. Here, we report a case of fingernail proximal subungual onychomycosis with associated skin infection caused by an opportunistic mold, Aspergillus sydowii, in a HIV positive individual. Isolation of A. sydowii from nail and skin of an immunocompromised person needs accurate identification for successful treatment.


Assuntos
Aspergilose/diagnóstico , Aspergillus/isolamento & purificação , Infecções por HIV/complicações , Dermatoses da Mão/diagnóstico , Hospedeiro Imunocomprometido , Onicomicose/diagnóstico , Adulto , Aspergilose/patologia , Dermatoses da Mão/patologia , Humanos , Masculino , Onicomicose/patologia
4.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413063

RESUMO

This case report presents a patient who, while undergoing oral isotretinoin therapy for acne vulgaris, developed onychocryptosis and asymptomatic external urethritis. These uncommon adverse events are not well-documented in medical literature. While his urethritis spontaneously resolved, his onychocryptosis symptoms necessitated surgical intervention. This report illustrates both cosmetic and functional adverse effects of isotretinoin and provides insight into the progression of these reactions over time.


Assuntos
Fármacos Dermatológicos/efeitos adversos , Dermatoses do Pé/diagnóstico , Isotretinoína/efeitos adversos , Onicomicose/diagnóstico , Uretrite/diagnóstico , Acne Vulgar/tratamento farmacológico , Administração Oral , Adolescente , Diagnóstico Diferencial , Dermatoses do Pé/induzido quimicamente , Dermatoses do Pé/complicações , Humanos , Masculino , Onicomicose/induzido quimicamente , Onicomicose/complicações , Uretrite/induzido quimicamente , Uretrite/complicações
5.
Dermatol Online J ; 25(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31450272

RESUMO

Onychomycosis is a prevalent disease of the nail. Traditional methods for diagnosis include direct microscopy with potassium hydroxide (KOH microscopy) and fungal culture. Other techniques using histochemical staining have higher sensitivity, but cannot identify genus or species of the infecting agent. PCR assays are sensitive, specific, and capable of genus and species level identification. We describe a real-time PCR assay for 15 different fungi that are associated with onychomycosis. Of 425 clinical samples suspected of onychomycosis analyzed by fungal culture and PCR, 219 samples were positive for both (52% agreement). Of the 206 discordant samples, 95% were resolved in favor of PCR by DNA sequencing. On a larger data set of 2,452 samples, positivity rates for histopathology, PCR, and culture were 85%, 73%, and 54% respectively. Further, 48% of PCR positive and 51% of histopathology positive samples were negative by culture. PCR outperformed culture compared to histopathology for sensitivity (80% versus 49%), specificity (92% versus 79%), positive predictive value (94% versus 77%), and negative predictive value (76% versus 52%). These results indicate the culture method lacks the sensitivity to be a reliable assay for onychomycosis, that PCR and histopathology are highly concordant, and that PCR provides the highest degree of diagnostic accuracy available.


Assuntos
DNA Fúngico/análise , Unhas/microbiologia , Unhas/patologia , Onicomicose/diagnóstico , Técnicas de Cultura , Humanos , Onicomicose/microbiologia , Onicomicose/patologia , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade , Análise de Sequência de DNA , Coloração e Rotulagem
6.
J Wound Ostomy Continence Nurs ; 46(4): 333-335, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274864

RESUMO

Toenail disorders account for the majority of foot complaints for which adults seek medical care. Onychomycosis, a fungal nail infection, is the most prevalent. Dermatophytes are responsible for the majority of nail infections and cause varying degrees of nail deformities. While several treatment strategies are available, no one approach (topical, systemic, or mechanical) is highly curative. This article reviews causes, diagnosis, and treatment options for onychomycosis and provides patient education tips to prevent and limit the spread of the disease.


Assuntos
Onicomicose/diagnóstico , Onicomicose/prevenção & controle , Onicomicose/terapia , Administração Tópica , Antifúngicos/uso terapêutico , Humanos , Terapia a Laser/métodos
7.
J Dermatol ; 46(10): 911-913, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342551

RESUMO

A 73-year-old healthy woman noticed black pigmentation on both thumbnails for 6 years. Upon her visit to our clinic, she had pigmented onychomycosis with onycholysis in the distal area. There was no evidence of paronychia. Direct microscopy using Zoomblue™ and histopathological examination showed aggregated blastoconidia. Fontana-Masson staining confirmed fungal melanin production. A combination of morphological features and genetic testing identified the isolates as Candida parapsilosis. Fungal melanonychia due to C. parapsilosis is rare, with only six cases reported since 1979. The minimum inhibitory concentration of the isolates was 0.25 µg/mL for itraconazole, less than 0.03 µg/mL for ravuconazole and 2.0 µg/mL for terbinafine. Both oral terbinafine treatment and itraconazole pulse therapy performed for 6 months were unsuccessful. The disease was ultimately cured with a 3-month treatment of oral fosravuconazole.


Assuntos
Candida parapsilosis/isolamento & purificação , Dermatoses da Mão/tratamento farmacológico , Melanose/tratamento farmacológico , Onicomicose/tratamento farmacológico , Tiazóis/administração & dosagem , Triazóis/administração & dosagem , Administração Oral , Idoso , Antifúngicos/administração & dosagem , Feminino , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Melanose/diagnóstico , Melanose/microbiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Pró-Fármacos/administração & dosagem , Resultado do Tratamento
8.
Rev Iberoam Micol ; 36(2): 72-78, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31153723

RESUMO

BACKGROUND: Onychomycosis affects between 2% to 30% of the world population. Nail biopsy may help in making a diagnosis and can distinguish between invasion and colonisation. AIMS: To evaluate the diagnostic usefulness of nail biopsy with Periodic acid-Schiff (PAS) staining for onychomycosis, compared to direct KOH examination, culture and its combination in a reference laboratory in Colombia. METHODS: The study included 66 patients in whom a blind and independent reading of the three tests was performed. The usefulness was defined based on the validity (sensitivity, specificity, Youden's index, likelihood ratios), performance (predictive values) efficiency (proportion of correctly diagnosed patients), and reproducibility (kappa coefficient). RESULTS: The mean age of the patients was 55±16 years, and included 76% women. The direct tests with KOH were positive in 66.7% (n=44), 62.1% (n=41) were positive with culture, and 56.1% (n=37) with the biopsy. The main causal agents were non-dermatophytes moulds in 36.4% (n=24). The most frequent species were Neoscytalidium dimidiatum (n=11), Trichophyton rubrum (n=11), and Candida parapsilosis (n=13). The sensitivity of nail biopsy, when compared to the standard (KOH and/or culture), was 71%, specificity 83%, Youden's index 0.54, positive likelihood ratio 4.25, negative likelihood ratio 0.35, positive predictive value 92%, negative predictive value 52%, efficiency 74% and kappa coefficient 0.45. When biopsy was evaluated only in patients with onycholysis of the nail plate greater than 50%, all the parameters of diagnostic usefulness increased. CONCLUSIONS: The overall usefulness of the biopsy was moderate for patients with more severe symptomatology, which makes its use advisable in cases of extensive onycholysis, and when discriminating colonisation from invasion is required.


Assuntos
Unhas/patologia , Onicomicose/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Colômbia , Feminino , Humanos , Hidróxidos , Indicadores e Reagentes , Masculino , Pessoa de Meia-Idade , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Compostos de Potássio , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coloração e Rotulagem , Adulto Jovem
9.
J Dermatol ; 46(8): 641-651, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206779

RESUMO

We evaluated the efficacy of efinaconazole 10% topical solution in long-term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE-t, suggested that efinaconazole treatment improved the patients' quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long-term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.


Assuntos
Antifúngicos/administração & dosagem , Dermatoses do Pé/tratamento farmacológico , Onicomicose/tratamento farmacológico , Triazóis/administração & dosagem , Administração Tópica , Idoso , Antifúngicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Dermatoses do Pé/diagnóstico , Humanos , Incidência , Assistência de Longa Duração/métodos , Masculino , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Qualidade de Vida , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Triazóis/efeitos adversos
11.
Rev. iberoam. micol ; 36(2): 72-783, abr.-jun. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-185479

RESUMO

Antecedentes: La onicomicosis afecta a entre el 2 y el 30% de la población mundial; la biopsia ungueal facilita el diagnóstico y diferencia invasión de colonización. Objetivos: Evaluar la utilidad diagnóstica de la biopsia ungueal con coloración de PAS en las onicomicosis frente al examen directo con KOH, el cultivo y su combinación en un laboratorio de referencia de Colombia. Métodos: Se incluyó a 66 pacientes, a quienes se les realizó lectura ciega e independiente de las tres pruebas; la utilidad se definió a partir de los resultados de validez (sensibilidad, especificidad, índice de Youden, cocientes de probabilidad), desempeño (valores predictores), eficiencia (proporción de pacientes correctamente diagnosticados) y reproducibilidad (índice kappa). Resultados: La edad media de los pacientes fue 55 ± 16 años, el 76% fueron mujeres y el 66,7% (n = 44) de los exámenes directos con KOH resultaron positivos; para el cultivo, el 62,1% (n = 41) de las muestras fueron positivas y con la biopsia lo fueron el 56,1% (n = 37). Los principales agentes causales fueron mohos no dermatofitos en un 36,4% (n = 24) y las especies con la mayor frecuencia fueron Neoscytalidium dimidiatum (n = 11), Trichophyton rubrum (n = 11) y Candida parapsilosis (n = 13). La sensibilidad de la biopsia ungueal frente al KOH o el cultivo fue del 71%, la especificidad del 83%, el índice de Youden 0,54, el cociente de probabilidad positivo de 4,25, el cociente de probabilidad negativo de 0,35, el valor predictivo positivo el 92%, el valor predictivo negativo el 52%, la eficiencia el 74% y el coeficiente kappa 0,45. Al evaluar la biopsia solo en pacientes con onicólisis de la lámina ungueal superior al 50%, aumentaron todos los parámetros de utilidad diagnóstica. Conclusiones: La utilidad global de la biopsia fue moderada para pacientes con mayor sintomatología, por lo que se recomienda su uso en presencia de onicólisis extensa y en los casos en los que se requiera discriminar colonización de invasión


Background: Onychomycosis affects between 2% to 30% of the world population. Nail biopsy may help in making a diagnosis and can distinguish between invasion and colonisation. Aims: To evaluate the diagnostic usefulness of nail biopsy with Periodic acid-Schiff (PAS) staining for onychomycosis, compared to direct KOH examination, culture and its combination in a reference laboratory in Colombia. Methods: The study included 66 patients in whom a blind and independent reading of the three tests was performed. The usefulness was defined based on the validity (sensitivity, specificity, Youden's index, likelihood ratios), performance (predictive values) efficiency (proportion of correctly diagnosed patients), and reproducibility (kappa coefficient). Results: The mean age of the patients was 55 ± 16 years, and included 76% women. The direct tests with KOH were positive in 66.7% (n = 44), 62.1% (n = 41) were positive with culture, and 56.1% (n = 37) with the biopsy. The main causal agents were non-dermatophytes moulds in 36.4% (n = 24). The most frequent species were Neoscytalidium dimidiatum (n = 11), Trichophyton rubrum (n = 11), and Candida parapsilosis (n = 13). The sensitivity of nail biopsy, when compared to the standard (KOH and/or culture), was 71%, specificity 83%, Youden's index 0.54, positive likelihood ratio 4.25, negative likelihood ratio 0.35, positive predictive value 92%, negative predictive value 52%, efficiency 74% and kappa coefficient 0.45. When biopsy was evaluated only in patients with onycholysis of the nail plate greater than 50%, all the parameters of diagnostic usefulness increased. Conclusions: The overall usefulness of the biopsy was moderate for patients with more severe symptomatology, which makes its use advisable in cases of extensive onycholysis, and when discriminating colonisation from invasion is required


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Unhas/patologia , Onicomicose/patologia , Biópsia/métodos , Colômbia , Hidróxidos , Indicadores e Reagentes , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Compostos de Potássio , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coloração e Rotulagem
12.
Mycoses ; 62(8): 659-664, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062415

RESUMO

Because of their similar clinical presentation, discrimination between nail psoriasis and onychomycosis often is difficult. We aim to investigate the actual frequency of onychomycosis in psoriatic patients and to compare it between psoriatic and non-psoriatic patients. This retrospective study included a total of 9281 patients, referring to our Mycology Laboratory from September 2003 to May 2018. The patients are divided into two groups: PsoGroup (patients with psoriasis) and non-PsoGroup (non-psoriatic patient). Direct microscopic examination with 20% KOH and culture was carried out in both groups. In PsoGroup (711 patients, 59.50% female, 40.50% male, median age of 52.22 ± 15.01), the prevalence of onychomycosis was 49.08%. On the other hand, in non-PsoGroup (8570 patients (71.65% female, 28.35% male, median age of 48.51 ± 19.31 years), the prevalence of onychomycosis was 51.30%. There was no statistically significant difference between the prevalence of onychomycosis in PsoGroup 49.08% (349/711) compared to 51.30% (4397/8570) of non-PsoGroup (P = 0.2578). However, yeasts were significantly more prevalent in non-psoriatic than in psoriatic patients (P = 0.0144.). In our Mycological Laboratory, we observed a similar prevalence of onychomycosis in psoriatic patients and non-psoriatic patients. However, the spectrum of fungal species isolated was different from each other, with a higher prevalence of yeasts in non-PsoGroup that reflect a recent oriental trends.


Assuntos
Dermatoses da Mão/epidemiologia , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Psoríase/epidemiologia , Adulto , Idoso , Arthrodermataceae/isolamento & purificação , Aspergillus/isolamento & purificação , Candida/isolamento & purificação , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/patologia , Onicomicose/microbiologia , Prevalência , Psoríase/microbiologia , Estudos Retrospectivos
13.
J Am Podiatr Med Assoc ; 109(1): 57-63, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30964314

RESUMO

BACKGROUND: Onychomycosis is a fungal infection of the nail that is often recalcitrant to treatment and prone to relapse. Traditional potassium hydroxide and culture diagnosis is costly and time-consuming. Therefore, molecular methods were investigated to demonstrate effectiveness in diagnosis and to quantify the microbial flora present that may be contributing to disease. METHODS: A total of 8,816 clinically suspicious toenail samples were collected by podiatric physicians across the United States from patients aged 0 to 103 years and compared with a control population (N = 20). Next-generation sequencing and quantitative polymerase chain reaction were used to identify and quantify dermatophytes, nondermatophyte molds, and bacteria. RESULTS: Approximately 50% of suspicious toenails contained both fungi and bacteria, with the dermatophyte Trichophyton rubrum contributing the highest relative abundance and presence in 40% of these samples. Of the remaining 50% of samples, 34% had bacterial species present and 16% had neither. Fungi only were present in less than 1% of samples. Nondermatophyte molds contributed to 11.0% of occurrences in fungus-positive samples. All of the control samples were negative for fungi, with commensal bacterial species composing most of the flora population. CONCLUSIONS: Molecular methods were successful in efficiently quantifying microbial and mycologic presence in the nail. Contributions from dermatophytes were lower than expected, whereas the opposite was true for nondermatophyte molds. The clinical significance of these results is currently unknown.


Assuntos
Unhas/microbiologia , Onicomicose/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , DNA Bacteriano/isolamento & purificação , DNA Fúngico/isolamento & purificação , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Reação em Cadeia da Polimerase , Estados Unidos/epidemiologia , Adulto Jovem
14.
Med Mycol J ; 60(1): 1-4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814464

RESUMO

We present a 17-year-old Japanese male high school student, who had applied steroid ointment for atopic dermatitis, with fingernail onychomycosis due to Trichophyton tonsurans. He was found positive for T. tonsurans infection based on hairbrush culture performed due to an epidemic of T. tonsurans infection in his judo club. The hairbrush culture method is very important in screening for this infection, and dermatologists should examine the entire body of athletes who are found positive using this method. For the diagnosis of T. tonsurans infection, other than the skin and hair, the nails should also be checked by dermoscopy because the fingernail may be the origin of this fungus.


Assuntos
Atletas , Artes Marciais , Técnicas Microbiológicas/métodos , Unhas/microbiologia , Onicomicose/microbiologia , Tinha/microbiologia , Trichophyton/isolamento & purificação , Adolescente , Dermoscopia , Humanos , Japão/epidemiologia , Masculino , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Tinha/diagnóstico , Tinha/epidemiologia , Esportes Juvenis/estatística & dados numéricos
15.
J Drugs Dermatol ; 18(2): 190-195, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811142

RESUMO

Background: This study was designed to evaluate the safety, tolerability, pharmacokinetics (PK), and efficacy of tavaborole in pediatric patients. Study Design: In this open-label, single-arm study, pediatric patients (aged 6 to <17 years) with distal subungual onychomycosis affecting ≥20% of the target great toenail applied tavaborole once daily to all affected toenails (2 drops/great toenail, 1 drop/other toenail) for 48 weeks. In addition, a maximal-use subgroup (aged 12 to <17 years) applied tavaborole to all 10 toenails and ≤2 mm of surrounding skin for the first 28 days. Results: Treatment-emergent adverse events (TEAEs) were reported by 55.6% of patients; the most frequently reported (≥5% of patients) were nasopharyngitis, contusion, sinusitis, and vomiting. Most TEAEs and local treatment reactions (LTRs) were mild or moderate and considered unrelated to treatment. There was 1 serious AE (severe appendicitis, considered unrelated to treatment) and there were no deaths, discontinuations because of AEs, or dose adjustments because of AEs. The most frequently reported LTRs were erythema and scaling. The incidence of LTRs diminished over time. Tavaborole was absorbed systemically, and plasma concentrations were measurable. The PK parameters determined in this study under maximal-use conditions indicate that steady state was achieved within the study period. For efficacy, 8.5% of patients achieved complete cure (clear nail and negative mycology [negative fungal culture and negative potassium hydroxide wet mount]) at week 52, and 14.9% achieved complete/almost complete cure at week 52 (clear or almost clear nail [≤5% dystrophic or discolored distal toenail plate] and negative mycology). Conclusion: Tavaborole was well tolerated in this pediatric population, and safety, PK, and efficacy profiles were comparable with those in adults. Trial registration: ClinicalTrials.gov identifier: NCT03405818 J Drugs Dermatol. 2019;18(2):190-195.


Assuntos
Antifúngicos/administração & dosagem , Compostos de Boro/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Administração Tópica , Adolescente , Antifúngicos/química , Compostos de Boro/química , Compostos Bicíclicos Heterocíclicos com Pontes/química , Criança , Composição de Medicamentos , Feminino , Humanos , Masculino , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/química , Resultado do Tratamento
17.
Clin Exp Dermatol ; 44(4): e133-e139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30690760

RESUMO

BACKGROUND: Identification of onychomycosis is mainly based on clinical diagnosis with auxiliary diagnostic methods such as potassium hydroxide (KOH) microscopy, periodic acid-Schiff staining or fungal culture. However, each method is limited by its sensitivity and specificity. AIM: To develop a new test method using the common fungal end product, ergosterol, and investigate if it can be used as a new diagnostic tool. METHODS: We collected consecutive data from 20 participants with nail problems. Following clinical diagnosis, samples were taken for KOH microscopy and for mass spectrometry (MS) to check for the presence of ergosterol. RESULTS: Of the 20 cases collected, 7 were positive for fungal infection by MS. Four of these were already suspected to have onychomycosis, whereas one of the remaining three subjects was presumed to have dry nail and the other two to have onycholysis. The MS test seemed to be better at detecting combinations of nail conditions. Conversely, of the five patients clinically diagnosed as having onychomycosis, four had a positive MS result, whereas the fifth had negative results on both KOH and MS. Two other participants had a positive KOH test and were also found to have positive MS results. CONCLUSION: Detection of the presence of ergosterol by MS seems to be a useful tool for confirming onychomycosis. However, further studies are needed to verify the sensitivity and specificity of this MS method.


Assuntos
Cromatografia Líquida/métodos , Ergosterol/metabolismo , Micoses/metabolismo , Espectrometria de Massas em Tandem/métodos , Humanos , Hidróxidos/metabolismo , Microscopia/métodos , Micoses/microbiologia , Micoses/patologia , Doenças da Unha/microbiologia , Doenças da Unha/patologia , Unhas/metabolismo , Unhas/microbiologia , Unhas/patologia , Unhas/ultraestrutura , Onicomicose/diagnóstico , Onicomicose/metabolismo , Onicomicose/microbiologia , Reação do Ácido Periódico de Schiff/métodos , Compostos de Potássio/metabolismo , Sensibilidade e Especificidade
19.
Int J Dermatol ; 58(3): 319-324, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30246397

RESUMO

BACKGROUND: In the absence of a real gold standard, comparative studies are still done on diagnostic methods for onychomycosis. There are only a few attempts using latent class analysis to determine the value of polymerase chain reaction in comparison to conventional methods. We aimed to determine the value of histological examination in such a way for the diagnosis of onychomycosis. METHODS: Potassium hydroxide mount (KOH), culture and histological examination with periodic acid-Schiff (PAS), and Gomori's methenamine silver (GMS) stains were done in 106 patients having clinically suspected toenail onychomycosis. RESULTS: KOH was positive in 74% of the patients; culture in 14%; PAS in 30%; and GMS in 66%. According to the results of the latent class analysis, culture and PAS were highly specific but poorly sensitive; KOH, highly sensitive but poorly specific; and GMS, both highly sensitive and specific. CONCLUSIONS: Based on these results, we have proposed KOH as a screening test and GMS as a confirmatory test for the diagnosis of onychomycosis in our own practice. However, since positivity rates of different diagnostic methods vary widely in different centers, it is more suitable that every center should determine their own diagnostic strategy by evaluating their own results with latent class analysis.


Assuntos
Onicomicose/diagnóstico , Onicomicose/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Corantes , Feminino , Humanos , Hidróxidos , Indicadores e Reagentes , Análise de Classes Latentes , Masculino , Metenamina , Pessoa de Meia-Idade , Micologia/métodos , Onicomicose/microbiologia , Reação do Ácido Periódico de Schiff , Compostos de Potássio , Sensibilidade e Especificidade , Adulto Jovem
20.
Br J Dermatol ; 180(3): 637-646, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30216405

RESUMO

BACKGROUND: The determination of causative organisms of onychomycosis is still not optimal. There remains a need for a cheap, fast and easy-to-perform diagnostic tool with a high capacity to distinguish between organisms. OBJECTIVES: To determine whether attenuated total-reflectance Fourier transform infrared (ATR-FTIR) spectroscopy can detect and differentiate causative agents in culture-based, ex vivo nail and in vivo nail models. METHODS: A methodological study was conducted. Both the ex vivo nail model and in vivo pilot study were carried out in an academic university hospital. RESULTS: Analysis of cultured fungi revealed spectral differences for dermatophytes (1692-1606 and 1044-1004 cm-1 ) and nondermatophytes and yeasts (973-937 cm-1 ), confirmed by dendrograms showing an excellent separation between samples from different genera or species. Exploration of dermatophytes, nondermatophytes and yeasts growing on ex vivo nails exposed prominent differences from 1200 to 900 cm-1 . Prediction models resulted in a 96·9% accurate classification of uninfected nails and nails infected with dermatophytes, nondermatophytes and yeasts. Overall correct classification rates of 91·0%, 97·7% and 98·6% were obtained for discrimination between dermatophyte, nondermatophyte and yeast genera or species, respectively. Spectra of in vivo infected and uninfected nails also revealed distinct spectral differences (3000-2811 cm-1 , 1043-950 cm-1 and 1676-1553 cm-1 ), illustrated by two main clusters (uninfected vs. infected) on a dendrogram. CONCLUSIONS: Our data suggest that ATR-FTIR spectroscopy may be a promising, fast and accurate method to determine onychomycosis, including identification of the causative organism, bypassing the need for lengthy fungal cultures.


Assuntos
Arthrodermataceae/isolamento & purificação , Dermatoses do Pé/diagnóstico , Dermatoses da Mão/diagnóstico , Onicomicose/diagnóstico , Trichophyton/isolamento & purificação , Adulto , Idoso , Feminino , Dermatoses do Pé/microbiologia , Dermatoses do Pé/patologia , Dermatoses da Mão/microbiologia , Dermatoses da Mão/patologia , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/microbiologia , Onicomicose/patologia , Projetos Piloto , Estudo de Prova de Conceito , Espectroscopia de Infravermelho com Transformada de Fourier
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